06-1004321
Federal Way
CfWMUA77YDEVELOPMENr SERVICES
3:9425 8-A VENUE SOUIT1 • PO BOX 9718
FEDERAL WAY. WA 98063-9718
253-8352607- FAX 253-8352609
www.ckw federalwau.mm
The following is reauire
IM2 Z
MF CO ME EL PL DE EN FP
JAXJ�bCATION.
CITY
RROF FEDERAL
AY
DEPT
rtforTA� on - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS�^ �(� N ` '� SUITE/UNIT #
ASSESSOR'S TAR/PARCEL # 7 =Qv - 0,-0 LOT SIZE (Sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aaach-paralr P'gaef -VhJ W9,d d—,V U.V U -
PROJECT• •
TYPE OF PERMIT )<XUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed disc tion of Mork included on Skis li on Ram
/% %,, I
Ak'
�Uzd
PROJECT NAME (Name of Business or Owner Last
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
MAILING ADURIaS KZ
MZZ-
-- (�
COMPANY NAME. OFFICE PHONE
� � ��
k Homes
�,,%INNG ADDR�F/S�$-(�/� /� CIYf�S . Z mA CELL PHONE
IQ vqtv:(
CITY OF FEDERAL WAY BUSINESS LICENSE, NUMBER EXPIRATION DATE - FAX
'NUMB
E//R
--13 L
CONTRACTOR'S RFGISTRATIO14 NUMBER (eepy b[.eard required with each applleatioW EXPIRA-no DATE
L C L4. 95y . 0-7
C AME
OFFICEPH�EMA
TMPANY
WIC.,N
ADD SS
CELL PHONE
oVP�/
RELATIONSHIP TO PROTECT
Agent Other (Describe)
FAX NUMBER
(Vr� l -
❑ Architect ❑ Tenant ❑
EXISTING USE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLUM ❑ PRIVATE (SEPTIC)
r
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
FANS
HOODS (coo—rd i)
WOODSTOVES
FIRST
FIREPLACE INSERTS
RANGES
V
SECOND
FURNACES
GAS WATER HEATERS
THIRD
GAS PIPE OUTLETS
_�
NEW ADDRESS REQUIRED?
FOURTH
UP/SEPA/SU?
n YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
' SHOWERS
WATER CLOSETS nbn�t)
MISC (Describe)
DECK(COVERED?)
�_ SINKS
DRINKING FOUNTAINS
GARAGE CA ORT
NUMBER OF FLOO F AL
SUMPS
y
/
TOTALMU MOF
TOTALFaovoe MW
TOTALM
'NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
of Mechanical Work
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (coo—rd i)
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
_�
NEW ADDRESS REQUIRED?
G
UP/SEPA/SU?
n YES
o NO
BATHTUBS (or114b/Sba Combo)
' SHOWERS
WATER CLOSETS nbn�t)
MISC (Describe)
DISHWASHERS
�_ SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
a HOSE BIBBS
LAVS (Bathroom Smits)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
I cert{fg under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its o,01cers and employees, upon the accuracy of the Wormation supplied to the city as a part of
this application.
NAME/TITLE_h�ek(A
�Lw DATE r
(Signature) (77lle)
RELATIONSHIP TO PROJECT weer Agent ❑ Contractor N -j❑ Architect ❑ Other
FOR OFFICE USE ONLY
❑ NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
n YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #100 -January 1, 2006 Page 2 of 4 k\Handouts\Permit Application